CPT Code 65112

CPT code 65112 is a medical procedure code for the removal or revision of an eye socket.

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What is CPT Code 65112

CPT code 65112 is designated for a surgical procedure involving the removal of an eye, followed by the revision of the eye socket. This code is used specifically when a healthcare provider performs an enucleation (removal of the eye) and then carries out procedures to modify or reconstruct the eye socket, potentially to prepare for the placement of a prosthetic eye or to improve the appearance and function of the orbital area.

Does CPT 65112 Need a Modifier?

For CPT code 65112, which pertains to the removal of an eye or the revision of an orbital socket, several modifiers may be applicable depending on the specific circumstances of the surgery and billing considerations. Here is an ordered list of potential modifiers and the reasons for their use:

1. -22 (Increased Procedural Services): This modifier is used when the service provided is significantly greater than typically required. For example, if the surgery involves extensive adhesions or unexpected complications requiring additional time and effort beyond the usual service.

2. -51 (Multiple Procedures): Used when multiple procedures are performed during the same surgical session. This modifier helps to indicate that this procedure is one of several others being billed at the same time.

3. -52 (Reduced Services): Applied when a service or procedure is partially reduced or eliminated at the physician's discretion. This could be relevant if the planned procedure was partially completed or modified.

4. -53 (Discontinued Procedure): Used when a procedure is terminated due to unforeseen circumstances which may compromise the patient's well-being. For instance, if the patient has an adverse reaction during surgery and the procedure needs to be stopped.

5. -54 (Surgical Care Only): This modifier is used when one physician performs the surgical care only and another is responsible for the preoperative and postoperative management.

6. -55 (Postoperative Management Only): Used when one physician is managing the postoperative care but did not perform the surgery.

7. -56 (Preoperative Management Only): Indicates that a physician performed the preoperative care but did not perform the surgery.

8. -58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): This is used for a procedure that is planned prospectively or is more extensive than the original procedure.

9. -78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): Used when a return to the operating room is required to address a complication from the initial procedure.

10. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when a new procedure (unrelated to the original) is performed by the same physician during the postoperative period.

11. -80 (Assistant Surgeon): Used when an assistant surgeon is present to aid the primary surgeon during the procedure.

12. -AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used specifically when a non-physician practitioner assists in the surgery.

Each of these modifiers addresses specific scenarios that might affect how the procedure is billed and reimbursed, ensuring accurate and fair compensation for the services provided.

CPT Code 65112 Medicare Reimbursement

CPT code 65112, which pertains to the removal of an eye or the revision of an orbital socket, is generally reimbursed by Medicare. However, the specific amount of reimbursement can vary based on several factors including the geographic location where the procedure is performed, the setting (inpatient or outpatient), and the fee schedule in place for that year.

To determine the exact reimbursement amount, it is advisable for healthcare providers to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website. This schedule provides detailed information on the reimbursement rates for all CPT codes based on the locality. Additionally, providers should ensure that all documentation and coding are accurately completed to facilitate appropriate reimbursement.

Are You Being Underpaid for 65112 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to scrutinize contracts and identify discrepancies down to specific CPT codes, such as 65112 for eye removal or socket revision procedures, RevFind ensures that each claim is fully compensated according to your payer agreements. Schedule a demo today to see how RevFind can safeguard your revenues by ensuring accurate payments for every procedure code, including complex cases like CPT 65112.

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